During an afternoon symposium on Monday, June 28, two experts will review environmental factors that have been linked to increased risk of diabetes. The two-hour session, which begins at 2:15 p.m. ET, is titled Environmental Exposures and Susceptibility to Obesity and Metabolic Consequences—What Are the Main Drivers?

Carlos A. Monteiro, MD, PhD, Professor of Nutrition and Public Health and Scientific Coordinator of the Centre for Epidemiological Studies in Health and Nutrition, University of São Paulo, Brazil, will discuss ultraprocessed foods and their impact on health while contrasting two paradigms about the link between diet and health.

The traditional approach sees specific nutrients as the single mechanism connecting diet and health. Dr. Monteiro will advocate for a holistic approach that goes beyond nutrients and considers: the food matrix, which is comprised of the nutrient and non-nutrient components of foods and their molecular relationships; meals, which are combinations of food matrices; and eating modes, which covers when, where, and what else a person is doing while eating.

A worldwide increase in the consumption of ultraprocessed foods has probably been the main driver of the obesity and diabetes pandemic, said Dr. Monteiro, who will also examine policy implications related to the control of obesity, diabetes, and other noncommunicable diseases.

“The fact that today most food we consume is processed in some way, and the fact that food processing became a main unfavorable driver of changes in the food matrix, meals, and eating modes makes the holistic approach much more appropriate to discuss the association between diet and health, including in particular the risk of obesity and diabetes,” Dr. Monteiro said.

Sung Kyun Park, ScD, MPH, will discuss per- and polyfluoroalkyl substances (PFAS) as potential environmental risk factors for diabetes and obesity. Widely used in products such as nonstick cookware, carpeting, waterproof sportswear, food packaging, and firefighting foams, PFAS are known as “forever chemicals” because of their persistence in remaining in the environment and the body. They also have been detected in drinking water.

While the epidemiological evidence is limited, PFAS have been suggested as potential obesogens and diabetogens. Dr. Park, Associate Professor in the Department of Epidemiology, University of Michigan School of Public Health, will review findings from the Study of Women’s Health Across the Nation (SWAN), which identified associations between serum concentrations of PFAS and longitudinal trajectories of body composition and incident diabetes in a large study of a multiracial/ethnic cohort of women in midlife.

“I will show the first longitudinal evidence of body composition trajectories over 15 years that are associated with serum PFAS concentrations,” Dr. Park said. “This well-designed, long-term prospective study also shows that women in the highest tertile of PFAS serum concentrations were 50% to 60% more likely to develop diabetes compared with women in the lowest tertile.”

PFAS may be related to greater body size and body fat, increased rates of body weight over time, and higher risk of diabetes development, Dr. Park said. Reduced exposure to PFAS may provide a critical path to preventing population-wide diabetes and obesity risks, he added.